Tanya

 

TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 

 

 

WORKING WITH YOUR VET

 

ON THIS PAGE:


The Importance of a Good Vet


Working Together


Choosing a Vet


A Specialist Vet Or A General Vet


Other Professional Sources


A Second Opinion


If Your Vet Refuses to Assist


Changing Vets


Recordkeeping


 

 

HOME


Site Overview


Just Diagnosed? What You Need to Know First


Search This Site


 

WHAT IS CKD?


What Happens in CKD


Causes of CKD


How Bad is It?


Is There Any Hope?


Acute Kidney Injury


 

KEY ISSUES: PROLONGING LIFE


Phosphorus Control


Hypertension

(High Blood Pressure)


Proteinuria


Anaemia


Potassium Imbalances


Pyelonephritis (Kidney Infections) and Urinary Tract Infections NEW


Metabolic Acidosis


Kidney Stones


 

KEY ISSUES: HELPING YOUR CAT FEEL BETTER


Nausea, Vomiting, Appetite Loss and Excess Stomach Acid


Maintaining Hydration


The B Vitamins (Including Methylcobalamin)


Constipation


 

CAT FOOD DATA


Ways of Assessing Food Content, Including What is Dry Matter Analysis


How to Use the Food Data Tables


USA Canned Food Data


USA Dry Food Data


USA Cat Food Brands: Helpfulness Ratings


USA Cat Food Brands: Contact Details


USA Food Data Book


UK Canned Food Data


UK Dry Food Data


UK Cat Food Brands: Helpfulness Ratings


UK Cat Food Brands:

Contact Details


 

SUPPORT


Coping with CKD


Tanya's Support Group


Success Stories


 

SYMPTOMS


Important: Crashing


Alphabetical List of Symptoms and Treatments


Fluid and Urinary  Imbalances (Dehydration, Overhydration and Urinary Issues)


Waste Product Regulation Imbalances (Vomiting, Appetite Loss, Excess Stomach Acid, Gastro-intestinal Problems, Mouth Ulcers Etc.)


Phosphorus and Calcium Imbalances


Miscellaneous Symptoms (Pain, Hiding Etc.)


 

DIAGNOSIS: WHAT DO ALL THE TEST RESULTS MEAN?


Early Detection


Blood Chemistry: Kidney Function, Potassium, Other Tests (ALT, Amylase, (Cholesterol, Etc.)


Calcium, Phosphorus, Parathyroid Hormone (PTH) and Secondary Hyperparathyroidism


Complete Blood Count (CBC): Red and White Blood Cells: Anaemia and Infection


Urinalysis (Urine Tests)


Other Tests: Ultrasound, Biopsy, X-rays etc.


Renomegaly (Enlarged Kidneys)


Which Tests to Have and Frequency of Testing


Factors that Affect Test Results


Normal Ranges


International and US Measuring Systems


 

TREATMENTS


Which Treatments are Essential


Fluid and Urinary Issues (Fluid Retention, Infections, Incontinence, Proteinuria)


Waste Product Regulation (Mouth Ulcers, GI Bleeding, Antioxidants, Adsorbents, Azodyl, Astro's CRF Oil)


Phosphorus, Calcium and Secondary Hyperparathyroidism (Calcitriol)


Phosphorus Binders


Steroids, Stem Cell Transplants and Kidney Transplants


Antibiotics and Painkillers


Holistic Treatments (Including Slippery Elm Bark)


ESAs (Aranesp, Epogen etc.) for Severe Anaemia


General Health Issues in a CKD Cat: Fleas, Arthritis, Dementia, Vaccinations


Tips on Medicating Your Cat


Obtaining Supplies Cheaply in the UK, USA and Canada


Working with Your Vet and Recordkeeping


 

DIET & NUTRITION


Nutritional Requirements of CKD Cats


The B Vitamins (Including Methylcobalamin)


What to Feed (and What to Avoid)


Persuading Your Cat to Eat


2007 Food Recall USA


 

FLUID THERAPY


Oral Fluids


Intravenous Fluids


Subcutaneous Fluids


Tips on Giving Subcutaneous Fluids


How to Give Subcutaneous Fluids with a Giving Set


How to Give Subcutaneous Fluids with a Syringe


Subcutaneous Fluids - Winning Your Vet's Support


Dialysis


 

RELATED DISEASES


Heart Problems


Hyperthyroidism


Diabetes


Polycystic Kidney Disease (PKD)


Pancreatitis


Dental Problems


Anaesthesia


 

OBTAINING SUPPLIES CHEAPLY


UK


USA Online


USA Local (Fluids)


Canada


 

SAYING GOODBYE


The Final Hours


Other People's Losses


Coping with Your Loss


 

MISCELLANEOUS


Prevention


Feline CKD Research, Including Participation Opportunities


CKD Research in Other Species


Share This Site: A Notice for Your Vet's Bulletin Board or Your Local Pet Shop


Canine Kidney Disease


Other Illnesses (Cancer, Liver) and Behavioural Problems


Diese Webseite auf Deutsch


 

SITEOWNER (HELEN)


My Three CKD Cats: Tanya, Thomas and Ollie


My Multi Ailment Cat, Harpsie


Find Me on Facebook


Follow Me on Twitter


Contact Me


Home > Treatments > Working With Your Vet

 


Overview


  • Having a good vet is essential to your cat's chances of survival.

  • Ideally you want a knowledgeable, caring vet with whom you can work in partnership to give your cat the best care possible.

  • This page has tips on deciding whether your vet is the best vet to help you on your CKD journey, how to work together as a team, how to find another vet if you decide to move, and how to get a second opinion.

  • It also discusses the importance of recordkeeping.


The Importance of a Good Vet


 

If you want to be able to give your cat the best possible treatment, you need a good vet. Whilst not the only factor (it also depends upon your particular cat, how sick s/he is at diagnosis, how much s/he wants to fight, how well s/he copes with being handled etc.), a good vet can make all the difference to your cat's quality of life and chances of survival, whereas if you have to fight your vet for treatments, it is reducing your cat's chances of survival, not to mention using up your time and energy and stressing you out.

 

This is not only my opinion: Renal Disease (2006) Polzin DJ Delaware Valley Academy of Veterinary Medicine says "With appropriate therapy, cats with stages 2 and 3 CKD commonly survive 1 to 3 years...however, many survive much longer. A host of factors influence prognosis of CKD, both favorably and unfavorably. Included among these factors are the quality of medical care provided to the patient, the degree of interaction between the veterinarian and pet owner, and the level of owner commitment."

 

I do not wish to disparage vets, who work very hard to qualify, and most of whom genuinely love animals; but as in every other profession, some vets are good, others not so good, and a small percentage very poor. Thus it is essential that you can recognise a bad vet - your cat's life depends upon finding a good one. 

 


Working Together


 

Unfortunately, at initial diagnosis many of us do not know our vets that well and have no real relationship with them. In the dim and distant days when I had young, healthy cats and therefore didn't need to go to the vet very often, I didn't know the vets at my practice at all. I only went there because my family used the practice for my childhood dog, and they were fairly close to my home. For a long time I didn't even realise that I could ask to see a specific vet, so I just saw whoever was free. It did gradually dawn on me that I got on better with certain of the vets, so I started asking for appointments with them, and eventually relationships were formed. And Gill, I still haven't forgiven you for retiring!

 

So what should you look for? You need a vet with whom you can work in partnership. You do not have to like your vet (though I think it's probably better if you do), but you have to be able to communicate and work together. Even if your vet has superb diagnostic and caring skills, if your personalities clash, or if you are too intimidated to ask questions, you are not a good match.

 

It can be hard enough finding a vet you trust and respect, but finding one who is also skilled at managing CKD is an additional challenge. This does not mean your vet is incompetent. Most general vets will be good at what they deal with most of the time. Typically, they will be seeing primarily dogs and cats, who in the main are young, usually healthy animals, for vaccinations or the occasional infection. Unlike GPS for human patients, vets also regularly perform surgery such as neutering or teeth cleaning. Vets deal with multiple species and run busy practices (every vet I know works very long hours), and cannot possibly be expected to keep up with the latest research for every ailment in every species.

 

For this reason, it is not necessarily a dealbreaker if your vet is not up to speed on CKD, because as a general vet s/he simply does not have the time. What is more important is that your vet is willing to learn and is open to new information. This is where you come in. You are your cat's advocate. You know your cat best, and you can research treatments that might be suitable, ready to discuss them with your vet. This site will help you with that.

 

Forming a Partnership


Your goal therefore is to find a vet who accepts that you are a partnership. This is not being unreasonable, it  is essential to your cat's wellbeing. Evidence-based step-wise approach to managing chronic kidney disease in dogs and cats (2013) Polzin DJ Journal of Veterinary Emergency and Critical Care 23(2) pp 205–215 says "It is essential to develop an ongoing relationship with the pet owner because they will be expected to adhere to treatment recommendations and monitoring protocols over a long period. Failure to do so will result in a sub-optimum therapeutic response, which may lead to owner discouragement and unsatisfactory outcomes including premature euthanasia. After performing many clinical trials, it has become apparent to us that patient outcome is improved through an ongoing active relationship between the pet owner and the veterinarian."

 

Your Vet's Rôle


Your vet is the professional, with many years of training and experience. Your vet knows things you that you probably couldn't understand even if you tried. Therefore you should not be telling your vet how to do his or her job.

 

Good vets are prepared to listen, to answer all your questions, to explain all the options available to you (not just the ones they favour), including the risks and benefits of those options, and to admit they don't know everything. They should be prepared to read selected research papers you bring in (though it is unreasonable to expect your vet to read a 20 page research study overnight!). They should also accept that old age is neither a disease nor a diagnosis.

 

Being a vet is a stressful occupation and the suicide rate is scarily high. Accept that your vet is human and can have bad days. I don't think I could cope with a job that required me to put animals to sleep, but they do it, day in, day out. Treat your vet with courtesy and compassion. I hope you don't need to be told this, but basically treat your vet how you would like to be treated yourself.

 

Your Rôle


Your rôle is to care for your cat and report accurately to your vet what is happening.

 

You should listen to your vet, who has medical training which you do not have, because you may have got the wrong end of the stick. You should be on time for appointments, pay your bills promptly (or according to an agreed payment schedule), inform your vet of every treatment you are using (some people think their vet doesn't need to know about holistic treatments, but they do) and basically try to be the kind of client you would like to have yourself. You also have to be prepared to pay for your vet's time and expertise.

 

How you approach your vet can make all the difference. If you ask for a treatment with which your vet is not familiar, you are taking the vet out of his/her comfort zone, especially if you utter the dreaded words "I read it on the internet." Make it easier by providing supporting documentation (I'm not a vet, so I link to veterinary references to support what I say, and you should use these rather than my site itself if possible), and ask them to help you understand it. Perhaps offer to fax or e-mail it over and give your vet time to digest it; this can mean less pressure for both parties than talking face to face, and can help  avoid the risk of your vet losing face if s/he does not actually know about what you are asking about. This also ensures you don't forget to ask important questions. If you want your vet to do a lot of additional preparation and research, it is only fair to offer to pay more.

 

Make it clear to your vet that you will listen to his/her advice, but that you also would like your own views to be taken into account. You see your cat every day, your vet does not. Perhaps offer to make a deal regarding when you would consider letting go (see The Final Hours for more information on quality of life considerations).

 

The five most difficult veterinary clients (2011) Gair D & Hall Johnson C Firstline describes clients from a vet's perspective. I am definitely a Demander and I'm not ashamed of it. (I do try to do my demanding politely. Perhaps I am actually a Polite But Persistent Requester).

 


Choosing a Vet


 

If your cat is in crisis and you simply want to find somebody who is willing to give your cat a chance, you may not have much time to shop around. If you are in the UK in particular, just finding a vet who permits sub-Qs is a bonus, and you may be prepared to move on that basis alone.

 

If you do have the luxury of picking and choosing, below are some of the factors you may wish to consider. This is how I would go about obtaining the information I require:

  • Firstly, check the practice website to get a feel for the way it is run and to see if one of the vets catches your eye, e.g. a vet with a particular interest in CKD.

  • You can then call and speak to the receptionist or practice manager to find out basics such as cost or length of routine appointments (if the information is not on the website).

  • If you are lucky, you may even get to speak to a vet or a vet nurse/tech with your more technical questions. Do not abuse this, take just five minutes of their time, with them calling you back at a time convenient to them if necessary, and try not to exceed the time limit.

  • If you like the sound of the practice, consider making a paid for appointment to see the vet where you can discuss your cat's case and check out the facilities. You may not even need to pay for your first visit - some US chains (e.g. VCA, Banfield) often give you the first appointment free. Not everyone takes their cat to this appointment, but I figure if I'm going to see the vet anyway, it is helpful to see how the vet handles my cat.

Location


If you ever have to rush your cat to the vet in an emergency, time can be of the essence. Even for non-emergencies, it is less stressful for both you and your cat to have a vet nearby. However, it is better to travel to a more competent vet than to make do with a less competent one close by.

 

Mobile vets can be a good choice to reduce stress. As a bonus, they may see more elderly animals and therefore be relatively experienced at treating CKD.

 

Availability


You need to know both the practice hours and the vet's own hours. Some vets will only be at a practice for a day or two a week, which is not ideal if you want continuing care. If your vet is not there fulltime (and even if s/he is), ask to meet another vet at the practice so you have back up available in case of need.

 

Is it possible for you to e-mail your vet with questions/concerns in advance of appointments. Many vets would like this because it gives them time to prepare, but do not effectively give them two hours additional work and expect to get it for free - offer to pay extra as and when appropriate.

 

One very important question with a CKD cat is whether you can be seen on the same day if your cat requires it. I would never use a vet who did not do this.

 

If you are in the UK, vets are obliged to provide 24/7 cover, but this will not necessarily be from your own vet's practice, so ask about that. 24 hour emergency first aid and pain relief (2017) Royal College of Veterinary Surgeons Code of Protessional Conduct explains more about the requirements.

 

If you are in the USA, you will often have to travel to an ER facility for out of hours cover, so clarify which facility your vet uses.

 

Cost


This matters to most of us, but ideally it should not be the defining factor. Ask how much a consultation costs, and how much standard blood tests and blood pressure checks cost. Do they charge for every little thing, or might they give you smaller items for free, such as a syringe for assist feeding.

 

Also check hospitalisation costs - if your cat ever needs intravenous fluids, you don't want to get a nasty shock when you get the bill.

 

Can they provide CKD supplies at reasonable cost? If not, do they charge to write a prescription? This is now legal in the UK. If they do, ask if they make prescriptions valid for a year.

 

Appointments


Ascertain how long appointments last. One of my vets allocated 30 minutes to each appointment, which is obviously good. Strangely enough, he didn't charge more than other local vets whose appointments only lasted 10-20 mins.

 

If your vet only allocates shorter appointments, ask if you can book longer ones when necessary (paying more for the privilege, of course).

 

Facilities and Testing


My ideal is a cat-only practice, but I've never found one that worked for me. If you can't get that, you might at least be able to get a cats-only waiting area in a clean waiting room. Even better is a cats-only treatment area.

 

Watch how the vet handles your cat.

 

Ask if you can be present for basic testing. Many vets do not agree to this because there are potential liability issues if you get bitten or scratched by your own cat, even if you ask to stay, but my vet trusts me not to sue her in such circumstances. I always ask to be present for blood pressure testing in particular, because being away from me can increase my cat's blood pressure.

 

Clarify how easy it is to park and whether it is free.

 

Make sure they do not sedate all cats routinely for blood draws.

 

Promptness


Although some people care about punctuality, and this may matter if you have to get to work, it's not something that I stress over too much. Basically I figure that if the vet keeps me waiting because of another client, I also won't be rushed should my cat need longer on occasion.

 

What I do care about is that my vets share test results with me promptly. My vets ring me the same day that they receive specialised test results back, and have done so at 10 p.m. on occasion when something has been faxed over late at night and they know I will be worrying.

 

CKD Experience


It is worth asking how often the vet treats CKD cats and what is the usual treatment protocol.

 

It is encouraging if the vet has experience treating CKD cats over a period of years, and can deal with complications such as anaemia, but a less experienced, open-minded vet is not a problem for me.

 

Other Experience/Referrals


You also need to know how much experience your vet has in other areas, e.g. can basic surgery be performed in-house, who do they use if a cat's needs are outside their area of expertise or if they or you require additional help or a second opinion.

 

Remember, you cannot get everything you like in one vet, so decide what matters most to you. For me, having a vet whom I trust who listens to my suggestions and who can see my cat quickly in an emergency is more important than the fact that she charges to write me a prescription (though I still wish she didn't!).

 

Finally - it helps, but is not essential, if your vet likes cats.

 

Special Needs Pets has useful information on choosing a vet, and on working together with him or her.  

 

Veterinary Partner also has helpful suggestions on finding a good vet.

 

Pawnation has an article about how to find the right vet.

 


A Specialist Vet or a General Vet


 

If you live in a small town, you probably don't have much choice of vets.

 

If you live in a large city or near a vet school, you have more choices available to you.

 

In the UK, you will usually need a referral to a specialist from your main vet, but this is not always necessary in the USA.

 

General Vets


Most of us end up using a general vet. This is not necessarily a bad thing. Although I used an ACVIM diplomate vet (see below) in the USA who was excellent, my UK vet is a general vet in the small town where I live, and she is great. (Well, she was until she retired. I still haven't forgiven her).

 

Even general vets have access to specialists for chats about complicated cases.

 

If you're using a general vet, you may wish to find one who is interested in feline health. In the USA, The American Association of Feline Practitioners lets you search for a vet in your part of the USA. These vets do not necessarily have specialist training, but they like treating cats, which is encouraging.

 

Some people use mobile vets who come to their home. This is much less stressful for most cats. The American Association of Housecall Veterinarians can help you find a housecall vet in the USA. Your current vet may offer a housecall service, at least for some services, such as euthanasia.

 

Specialist Vets


Some people use specialist vets, either on an ongoing basis or occasionally.  This can be particularly helpful if your cat has multiple heath issues, e.g. CKD and pancreatitis or diabetes, or if there is a problem (e.g. a mystifying symptom) that your regular vet is unable to resolve. However, I used a board certified vet as my regular vet in the USA. If additional skills are available, why not make use of them?

 

Specialist Vets: USA


You may wish to use a vet who is an internal medicine specialist. I used such a vet in the USA. These vets have additional training, which can be very helpful when dealing with CKD. The American College of Veterinary Internal Medicine (ACVIM) has a list of its diplomates, who have undergone an additional three years specialist training. Search for a specialist in Small Animal Internal Medicine (SAIM).

 

Another option is to visit a vet school (veterinary teaching hospital). If you do this, your cat's care will be overseen by a specialist vet, but you will usually be dealing with other vets such as residents and will not necessarily even meet the specialist vet. Residents are fully qualified vets but they are still undertaking their specialist training. Vet students will probably also be involved in your cat's care, and will probably take the initial history, with the resident running through their findings with you. You can of course ask to speak to the specialist vet, though you may well have to wait in order to do so.

 

Vet schools and some specialist vets (especially if they work in a practice with other specialists) will have access to very sophisticated tests and equipment. They will also be used to dealing with complex cases. You may have to leave your cat there for several hours in order for all the tests to be performed, partly because the necessary tests can take a while, partly because it can take longer when trying to instruct student vets, and partly because emergency cases will take priority, as in any hospital.

 

In my experience specialists, especially at vet schools, will do tests on the first day, such as bloodwork, urinalysis and perhaps an ultrasound. You may then be able to take your cat home, and possibly return on another day for additional tests or surgery; or they may wish you to leave your cat for in-patient treatment such as intravenous fluids. None of this will be cheap, but it will be thorough.

 

I get mixed reports about US vet schools and specialists. Most of the time people are very happy with them, but occasionally they are a disappointment.

 

American Animal Hospital Association explains about hospital accreditation.

 

Specialist Vets in the UK


As in the USA, there are veterinary specialists available in the UK. They may work in private practice or at a vet school (veterinary teaching hospital).

 

The European College of Veterinary Internal Medicine has details of its diplomates throughout the world, including the UK.

 

Vet Index has details of some specialists.

 

If you visit a vet school, your cat's care will be overseen by a specialist vet, but you will usually be dealing with other vets such as residents and will not necessarily even meet the specialist vet. Residents are fully qualified vets but they are still undertaking their specialist training. Vet students will probably also be involved in your cat's care, and will probably take the initial history, with the resident running through their findings with you. You can of course ask to speak to the specialist vet, though you may well have to wait in order to do so.

 

The Animal Health Trust in Newmarket is a specialist veterinary charity which has an excellent reputation.

 

Vet Professionals was founded by Dr Sarah Caney, a feline specialist known for her caring approach. She offers e-mail advice to vets and will do telephone consultations with cat owners who are referred to her by their own vet for £300. She also runs referral clinics in Dunfermline.

 

The Royal Veterinary College in London (near Kings Cross) offers free health screening, follow up monitoring and therapeutic kidney diets for CKD cats. Medications and additional tests will be charged for. Eligible cats include cats who are aged at least nine who fall into one of the following categories:

  • Healthy cats
  • Cats diagnosed with chronic kidney disease who have not yet started eating a therapeutic kidney diet
  • Cats diagnosed with an overactive thyroid and not yet on medication
  • Cats diagnosed with high blood pressure
  • Cats suspected of having one of the conditions listed above

Cats with diabetes or other significant health problems are not eligible.

 

I maintain a private list of British vets who permit sub-Qs when appropriate. Most of them are not specialists, but they are open-minded about sub-Qs. If you are in the UK and need such a vet, please read here about how to obtain details of any vets in your area, though unfortunately the list is very short, so the chances of such a vet being in your area are sadly rather low.

 


Other Professional Sources


 

These are other sources of support and information which some people have found helpful.

 

Cornell Feline Consultation Service


Cornell Feline Health Center Camuti Consultation Service may be worth considering, as long as you or your vet can speak English. This service offers advice on feline health related issues. It cannot diagnose or guide treatment for your cat or offer a second opinion, but it can provide general information and support.

 

You need to provide as much information as possible (e.g. blood test results), then the consultant will contact you or your vet to discuss your cat's situation, usually within 48 hours but occasionally it takes a bit longer. The service costs US$55 and is available Mondays, Wednesdays, and Fridays, 9 a.m. - 12 p.m. and 2 p.m. - 4p.m. Eastern time (not holidays). If you are calling from outside the USA, you may have to pay for the cost of the call back from the consultant.

 

I have heard from a number of people who have used this service, and virtually all of them were very satisfied.

 

Cornell will not be able to assist if your cat is deceased.

 

Veterinary Information Network


The Veterinary Information Network offers assistance from 250 veterinary specialists, including four nephrology consultants, to its members. Your vet can join for US$58 a month, but a 30 day free trial is also available.

 


A Second Opinion


 

If you are concerned about your vet's approach, or if your cat has multiple heath issues, e.g. CKD and pancreatitis or diabetes, or if there is a mystifying symptom that your regular vet is unable to resolve, you may wish to seek a second opinion. Vet schools or feline specialists are a good choice if there is one in your area.

 

In the UK, if you ask for a second opinion, your vet should be happy to refer you. Referrals and second opinions (2017) Royal College of Veterinary Surgeons Code of Protessional Conduct states "Veterinary surgeons should facilitate a client's request for a referral or second opinion." Unfortunately it is not always easy finding a specialist to consult, though see specialist vets for some options.

 

Of course, you may decide simply to consult a second general vet if you have any concerns about the treatment your cat is currently receiving, or if you would just like a fresh pair of eyes. Do not disparage your current vet, this is not courteous and puts the second opinion vet in a difficult position.

 


If Your Vet Refuses To Assist


 

This is particularly common in the UK, especially for people who are trying to find a vet who will allow them to give sub-Qs to their cat, but people in other countries may also have problems.

 

f your vet is not helpful, you need to find out why this is the case. There are two main reasons why some vets may seem to be less than helpful:

 

Concern For Cat's Welfare


Firstly, the vet may think it is unfair on the cat, usually because they think there is no hope so any treatment is pointless (though in the UK, people also have trouble obtaining sub-Qs because the vet thinks they are too invasive).

 

You do need to respect your vet's knowledge and experience, and accept that it might well be true that your cat's case is hopeless. At the same time, most people also need to know they have done all they can to help their cat. Treatment may not always work, but not trying to treat certainly won't. As one member of Tanya's CKD Support Group put it, what adversely affects her cat's quality of life is denial of treatment.

 

The current situation is like a snapshot in time, especially if your cat has an infection, high blood pressure or is dehydrated, and things may change dramatically with appropriate treatment. No vet has a crystal ball. Contrary to popular opinion, medicine is not black and white, there are many shades of grey, and different vets will have varying knowledge and experience which will mean they may have different opinions, sometimes even within the same practice. So your vet's opinion is just that, an opinion, albeit a professional one.

 

Belief That The Client Does Not Wish to be Proactive


Secondly, upon receiving the CKD diagnosis, many people simply assume that things are dire and the end is nigh, especially if the vet uses the term "renal failure." Even if they knew of the treatment options described on this site, they would not be willing to try them or think their cat would not tolerate them, or they (or the vet) think they cannot afford them. Since most people take this approach, your vet may assume it is also your approach.

 

Thus, you need to make it clear to your vet that you wish to fight for your cat and be proactive. You also need to discuss your financial limitations, though if your vet is prepared to write you a prescription, you can often buy basic supplies cheaply online. If your vet doesn't know you very well, perhaps because your cat has always been very healthy up to now, you will also need to win your vet's trust.

 

If Your Vet Continues to Refuse to Assist


If your vet is still not helpful or hopeful, discuss the situation and see if you can nevertheless find a way to work together.

 

Your opinion matters. Communication and consent (2018) Royal College of Veterinary Surgeons Code of Protessional Conduct states "veterinary surgeons and veterinary nurses must accept that their own preference for a certain course of action cannot override the client's specific wishes, other than on exceptional welfare grounds." If you are in the UK, you could politely point this out and ask for your wishes to be respected.

 

It can be hard to do this, especially if you're not a particularly confident person who finds it hard to negotiate. Remember, negotiating is not about winning. It's about reaching an arrangement that both parties are reasonably happy with.

 

Your vet cannot insist on euthanasia without your input. Euthanasia of animals (2017) Royal College of Veterinary Surgeons Code of Protessional Conduct says "Where a veterinary surgeon is concerned about an owner's refusal to consent to euthanasia, veterinary surgeons can only advise their clients and act in accordance with their professional judgement. Where a veterinary surgeon is concerned that an animal's welfare is compromised because of an owner's refusal to allow euthanasia, a veterinary surgeon may take steps to resolve the situation, for example, an initial step could be to seek another veterinary opinion for the client, potentially by telephone."

 

Asking to treat for two weeks before making a decision to euthanise is a reasonable compromise that many vets can accept. Also see Subcutaneous Fluids: Winning Your Vet's Support for tips on this issue in particular and how to win your vet over generally.

 

If your vet still won't help, you will need to either get a second opinion, which may help persuade your vet to work with you, or find a new vet. See below for suggestions on how to do this.

 

How to speak for Spot (2009) Kay N discusses how to decide which treatments would be the best choice for your dog in your particular circumstances but the principles apply to cats too.

 

Why your vet won't help you and what to do about it Chandroo K has some suggestions about what to do in this situation.

 


Changing Vets


 

If you feel that your current vet is not the best fit for you and your cat, or if your vet refuses to treat your cat in a way that you deem appropriate, you will have to change vets. See above for tips on choosing a vet.

 


Recordkeeping


 

It is a good idea to keep your own records, so you can monitor trends and have information readily available should you decide to move (either town or vet).

 

It is particularly important to keep your own records if you are in the USA, because most people in the USA have to go to the ER if their cat is sick out of hours, and it is very helpful to the ER staff if you can provide them with records.

 

Keeping Records


I strongly recommend keeping your own records of your cat's symptoms and behaviour on a daily basis, together with bloodwork results and which treatments you have tried, and those which you continue to use. This can help you to monitor trends, and can also serve as a reminder of what treatments worked should a symptom recur some months later. 

 

My Mum is developing a worrying interest in trips to A&E (the ER) in ambulances. I have a one page summary of her medical history which I can show to the paramedics and doctors, and they have all said how helpful it is. Having something similar for your cat is advisable.

 

Be very sure to keep records of allergies, particularly to drugs, and make sure these are clearly marked on your cat's notes.

 

Setting up a spreadsheet with space for daily entries can be very helpful because it means you are less likely to forget to records information. I would recommend recording the following:

  • weight (and when weighed

  • blood pressure

  • food and fluid intake

  • medications given

  • litter box usage

  • respiration rate, especially if your cat has heart disease

  • symptoms

  • activity level

Vitus Vet Pet Medical Records is a free app that has good reviews. It is also available for android phones.

 

Obtaining Records From Your Vet


You should always keep records of your cat's blood tests etc at home, especially if you are in the USA and need to visit an ER vet if your cat requires urgent help when your vet's office is closed.

 

Some practices are strangely reluctant to share records. I think some of them worry that a little knowledge can be a dangerous thing (and they are right in some cases). I've also been told in the past by a vet nurse that there was no point giving me my cat's records because "you won't understand them." I must admit, that gave me a bit of a giggle. In fairness to the vet nurse, she didn't know I run this site, and what she said is probably true of most of their clients.

 

From what I hear, if you ask the receptionist for your records, you will often be refused. Therefore I would ask your vet for copies at the end of each appointment. They may prefer to e-mail them over to you later, but be sure you have copies at home. If this happens, ask the vet directly, who will probably agree.

 

If you continue to have trouble obtaining copies of your records, especially in cases where the clinic says the records belong to them (which they do, but you are entitled to copies), you can insist as follows:

 

Clinical and client records (2017) Royal College of Veterinary Surgeons Code of Professional Conduct requires that vets must give owners records and test results when asked to do so, although they can charge for doing so.

 

The American Veterinary Medical Association states "Veterinarians are obligated to provide copies or summaries of medical records when requested by the client. Veterinarians should secure a written consent to document that provision."

 

However, ongoing problems in this area may indicate that this practice is not going to too good at treating you as a partner in your cat's care.

 

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    This page last updated: 12 May 2018

    Links on this page last checked: 12 May 2018

     

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